Compression To Ventilation Ratio For Infant

The term CPR ratio refers to the ratio of chest compressions to rescue breaths when performing CPR. In other words, how many compressions should you give for every breath in order to optimize the oxygenated blood that’s being manually pushed through the cardiovascular system and ultimately into the brain. In the CPR world, there are very specific guidelines to this, especially with infants.

What is the CPR ratio for an infant child?

The CPR ratio for an infant child is actually the same as the ratio for adults and children, which is 30:2. That is, when performing CPR on an infant, you perform 30 chest compressions followed by 2 rescue breaths. According the the American Heart Association and ILCOR, it is certainly permissible to perform “hands only” CPR on adults and older children. But for infants, it’s absolutely recommended to weave in the two breaths every 30 compressions.

How do I perform chest compressions on an infant?

Chest compressions on an infant are performed differently than chest compressions on an adult or child. Because an infant is more fragile, the compressions should be performed with only two fingers, at the center of the chest, just below the nipples. Compressions should be about an inch and a half deep and at a rate that coincides with the beat of the song “Staying Alive” by the Bee Gees.

How do I perform rescue breaths on an infant?

Performing rescue breaths on an infant is quite different than performing them on adults, or even on older children.

For adults and children aged one or older, you should pinch the nose shut with your fingers while covering the victim’s mouth with your own to perform rescue breaths. This is not possible to do effectively with an infant. Because of this, when performing rescue breaths on an infant, you should cover the infant’s mouth and nose with your mouth, creating a tight seal.

There are a couple other important differences concerning rescue breaths for infants.

One is the angle of the head. Any victim’s head should be tilted slightly backwards before performing rescue breaths, so as to open the airway. However, it’s important to not tilt the head back too far, and it’s very easy to overdo it with an infant. Because of this, many people recommend tilting the baby’s head back very slightly in a “sniffing position,” just back far enough so that it looks like the infant is sniffing the air. This gets the baby’s head at the right angle.

Another big difference is the power of the breath. A full adult breath would be too much for an infant, so instead of using your lungs to administer the breath, it’s recommended to just fill your cheeks with air and use that breath as the rescue breath.

What should I do after I perform chest compressions and rescue breaths?

CPR should only be performed if the infant is unconscious or unresponsive. If the infant regains consciousness, stop performing CPR and call 911. Stay with the infant, monitoring them closely, until help arrives.

If the infant does not regain consciousness, perform 5 cycles of CPR (i.e. 30 compressions and 2 rescue breaths, repeated 5 times) and then call 911. After you have called for help, continue performing CPR until emergency services arrive.

(Note: for infants and children, immediate CPR is vital. If you are alone with the infant, perform at least 5 cycles of CPR before pausing to call 911. If you are not alone with the infant, one person should call 911 immediately while the other begins CPR.)

Remember this: the purpose of CPR is not to bring a child back to consciousness, but to manually perform the work of the cardiovascular system until advanced medical help arrives.

How can I remember the CPR ratio for an infant child?

The best way to learn and retain all proper CPR techniques is to take a CPR certification course, and review the course materials often to keep the information fresh in your mind.

Infant CPR offers online certification courses that are convenient and comprehensive, so you can receive quality CPR training from the comfort of your home. Once you’ve enrolled in one of our courses, you have unlimited access to the material, so you can refer to it any time you need to brush up on your skills.

What Is The Compression To Ventilation Rate For Infants

Different ages of people require a different set standard for CPR ratios. For instance, a baby is different than a child, a child is different than the average adult, and the average adult is different than the elderly person. Therefore, a person’s size has much to with the way CPR is done. For instance, a Barro-chest, burly man may require a strong person to push on his chest, rather than a person who is small or doesn’t possess the capacity to push hard, fast and deep. For an elderly person, pushing hard, fast and deep may cause ribs to break, and of course, the baby or infant requires less effort, so what are the acceptable standard CPR Ratios  The anatomy of the inside of the chest cavity for all ages is essentially the same. The distance from the top of the chest to the heart is typically identical, minus birth defects, trauma or a thoracic (chest) surgical procedure. The idea is to squeeze the heart between the chest bone and the backbone to allow for artificial circulation. Typically, the compression level equals or is close to two inches which means that it pertains to all ages, give or take a couple of inches.  

In the old days before the American Heart Association changed the standards due to research, compression depth and rate for the dissimilar ages were not the same. Research has shown that one or two-person CPR requires the same or a slight change. For a single rescuer performing CPR on an adult, child, infant, or neonate, the compression ratio is 30/2. The changes are minuscule but require quick reaction. For each 30 compressions, two breaths are given. However, in today’s world, giving breaths may turn out to be detrimental for the rescuer because of diseases. However, for healthcare providers, using a pocket mask or breathing device is required. The AHA does not mandate breaths from the layperson but that chest compressions at 100 to 120 per minute is started without delay.

Standard Chest Compression Ratios for Adults

When chest compressions are done at 100-120 per minute, the idea is to be exact or in-between 100 and 120. Too fast or too slow does not always provide adequate perfusion. Hence, the most important component of CPR is chest compressions. If no other rescuer arrives, single rescuer CPR must be maintained until the arrival of Emergency Medical Services. But what about two-person CPR?

Two Person CPR Approach for Compressions

Two-person CPR is accomplished in the same manner. However, there is a change when it comes to children, infants, and neonates. For instance, when another rescuer arrives to help the single rescuer with CPR on an adult, the ratio does not change. The ratio remains 30/2. When a second rescuer arrives to help with CPR on children, infants, and neonates, the ratio changes from 30/2 to 15/2. The compression debt ratio for an infant is at least one third the depth of the chest which is about 1 ½ inches or 4 cm. The depth of compression ratio for a child is at least one third the depth of the chest which is about 2 inches or 5 cm. The depth of compression ratio for an adult is at least 2 inches which is 5 cm, all with a rate of 100-120 per minute.

Techniques and Approach for Adults, Children and Infants  

When placing the hands on the chest of an adult, two hands should be used. When placing the hands on a child (depending on how big the child is) one or two hands should be used. When performing chest compressions on an infant or neonate, two fingers are used for a single rescuer, and two thumbs encircling techniques is used for two rescuers. A neonate is less than one month old. The infant is less than one year old. The child is less than eight years old. However, breast development in the females and chest hair can determine if the child is older than eight years. The elderly is fragile, and their ribs are easily broken when CPR is started. It is important to start CPR regardless of whether ribs are broken or not.  It is extremely important to allow complete recoil without removing the hands or fingers from the chest. To do so does not allow adequate artificial perfusion, which gets oxygenated blood to the brain. The importance of proper CPR with this ratio can allow for cerebral perfusion until EMS arrives. Furthermore, it is understood that there are many people untrained in the technique of CPR. Getting trained makes a difference but pushing on the chest even without training is better than nothing at all. Ultimately, understanding the science and knowing the ratios behind proper CPR makes a difference in survival.

Frequently Asked Questions

What is the Correct CPR Ventilation/Compression Ratio?

The correct ventilation/compression ratio for adults is 30:2. It simply means to provide 2 rescue breaths after 30 compressions, and maintain a steady rhythm. The same is to be followed for both single and double rescuer methods. If there is an additional rescuer, the same method is to be followed, except that each person can take turns with performing the rescue breaths and the compressions without pausing either. This also enables them to rest from the physically laborious job of giving compression.

Is the Compression Ratio the Same for Children and Infants as well?

No, the compression ratio for children is 15:2. Most child and infant victims require emergency medical care due to choking or drowning. Because of this, giving more frequent rescue breaths is imperative. In case of a single rescuer, for a drowning or choking case a rescue breath for every five to ten breaths since the victim needs oxygen to be provided.

What if there is any External Devices Involved?

If an AED or Automated external defibrillator is available alternate 3-4 shocks with a minute of CPR. AEDs are designed to help untrained rescuers perform near-successful CPR. CPR should be continued till you see the patient breathing herself (chest rise and fall) or if the victim regains consciousness. Immediate care to discover the cause of the attack however should be offered to the victim, to understand the root of the problem. While practicing successful rescues on victims may not promise a hundred percent survival, it does give them another chance at life, and that chance no matter how small is deserved by everyone.

Recommended Compression To Ventilation Ratio For Infant 2 Rescuer

The air that the lungs inhale contains oxygen and the heart supplies that oxygen along with the blood to various parts of the body. If the baby stops breathing or the heart stops beating then it can cut off the flow of oxygen to the vital organs. This can lead to brain damage within four minutes and/or even death in four to six minutes.

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Unlike adults, CPR in babies is required in case of respiratory issues that can lead to cardiac arrest.

The reasons that can cause a baby’s heartbeat or breathing to stop include:

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  • Drowning
  • Poisoning
  • Smoke Inhalation
  • Sudden Infant Death Syndrome (SIDS)
  • Electric Shock
  • Severe Asthma
  • Head Trauma
  • Obstructive Apnea
  • Injury or Illness

What is CPR?

CPR is short of Cardiopulmonary Resuscitation. It is an emergency lifesaving technique used to keep the blood flowing through a person’s body when the heart stops beating. It involves chest compressions to keep the blood flow intact and rescue-breathing to provide oxygen to the lungs.

Time becomes a factor of big concern while you are dealing with an unconscious baby. CPR is most effective when performed at the earliest. Doing CPR in babies will help deliver oxygen to the brain until help comes or the baby recovers.

Difference Between Doing CPR in Babies and Adults

Two Finger Encircling Hand CPR

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CPR is performed in adults and infants for the same reason – to help lung and heart work when they cannot. But there are certain differences that one should keep in mind while performing CPR on babies:

1. Do Not Shake the Baby

While checking for responsiveness, do not shake the baby as it may cause brain damage. You should call the baby loudly while tapping the soles of their feet.

2. Checking Pulse

In an infant, one should use a bilateral brachial artery to check the pulse. To do so press 2 to 3 fingers gently on the inner side of the upper arm for 5 to 10 seconds.

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3. The Depth of Compressions

In an infant should be 1/3rd the depth of their chest or 1.5 inches.

4. The Technique of Compression

Use the 2 finger technique. When there is only one rescuer present, use two fingers for chest compression. Place two fingers, just below the nipple line, in the center of the infant’s chest. Push the chest to the 1/3rd of the chest or one and a half inches. In between compression, allow the chest to regain its position. Perform the compression at the rate of 100-120 compression per minute.

5. Two Finger Encircling Hand Technique

If there are two rescuers, the compression to ventilation ratio becomes 15:2. Sit near the baby’s feet and place two thumbs side by side, just below the nipple line in the center of the chest. Encircle the chest in such a way that the fingers of both hands hold the back of the baby. Start the compression using thumbs at the rate of 100-120 compression per minute. The depth of compressions should be 1/3rd of the chest. This technique allows another rescuer to support breathing without coming in the way. This technique is preferred.

6. The Compression to Ventilation Ratio

While performing CPR in a baby this should be 30:2 in the case of one rescuer. If there are two-rescuer you can give 15 compressions and 2 breaths.

7. Calling Emergency Services

Adults require CPR when they go into cardiac arrest. However, infants need CPR when they are in a respiratory problem before going into cardiac arrest. The aim is to not let the baby go into cardiac arrest. Cardiac arrest means the baby becomes suddenly unresponsive. Hence, if you did not see the baby go into cardiac arrest then first administer CPR for two minutes before calling emergency service. And if you see a baby go into cardiac arrest then first call emergency service and then start CPR again.

When is CPR Performed in Infants?

One should only perform CPR in infants only when they are either unresponsive, unconscious, not breathing normally or there are no signs of life.

What are the Considerations Before Giving a Baby CPR?

first aid for baby before CPR

We understand that as parents or caretakers you need to take urgent steps to make the baby responsive, but there are a few precautions & steps you need to take while giving a baby CPR:

  1. Check the surroundings. If you are not in a safe place like you are near water then take the baby to a safe place. If you are in a safe place don’t move the baby.
  2. Check the responsiveness in the baby by calling them out and flicking on the sole of their feet. Do not shake the baby.
  3. Check for breathing for no more than 10 seconds.
  4. If the baby is not responding, call someone from around for help. Do not leave the baby to call for help. If you are alone, administer two minutes of care then call emergency services. If you get help, ask them to call emergency services.
  5. Make the baby sleep on its back and open the airway. Tilt the baby’s head slightly back and lift the chin.
  6. If the baby is not breathing, use your mouth to seal the baby’s mouth and nose. Blow for one second and let the chest rise. Give a second rescue breath in the same way.
  7. If the baby does not respond to rescue breathing, perform CPR.

How to Perform Baby CPR?

Keep the following steps in mind if you are performing the Baby CPR alone:

1. Sit down beside the baby. Position the baby on its back.

Step 1 of CPR in Babies

2. Place two fingers in the center of the baby’s chest, below the nipple line. Give 30 compressions at the rate of 100 to 120 per minute. Count as you perform the compression. Depth of compression should be 1.5 inches deep or 1/3rd the depth of the chest. Remember Push hard – Push fast.

step 2 of CPR in babies

3. Open the airway by lifting the head slightly backward and lifting the chin. Remember not to tilt the head too far back.

step 3 of CPR in babies

4. Seal baby’s nose and mouth with your mouth and give two gentle breaths of one second long each. Make sure you see the baby’s chest rising after each breath. Do not force ventilation just gently, else it can cause lung damage.

step 4 of CPR in babies

5. Continue performing CPR in the same way – 30 compression 2 breaths – until you see signs of life or help arrives.

What Should be the CPR Ratio for an Infant?

Performing CPR in a baby includes both chest compression and mouth-to-mouth ventilation (rescue breaths). CPR ratio gives infant CPR compression to ventilation rate. This shows for every breath how many compressions are required to optimize the flow of oxygenated blood through the cardiovascular system and to the brain.

When it comes to performing CPR for infants one cannot forget the CPR ratio. The CPR ratio for an infant is 30:2. That means to give 30 chest compressions followed by two rescue breaths.

If you are giving two-rescuer CPR (explained below) you can shift the ratio to 15:2.

What are One Rescuer CPR and Two Rescuer CPR For Infants?

One rescuer and two-rescuer CPR for infants simply indicates the number of rescuers who are available to perform CPR. If you are alone, perform the one rescuer for an infant. If there is another person with you or someone who comes to give help perform two-rescuer CPR for infants. The technique in two-rescuer CPR enables more steady compressions and blood flow as compared to one-rescuer CPR.

How to perform one rescuer and two-rescuer CPR is mentioned below.

One Rescuer CPR for Infants

  1. Check if the baby is responding by calling him or her loudly while tapping the sole of the feet. Check the baby’s breathing. If it is not normal, call for help.
  2. When someone comes, ask them to call the emergency service. In case you are alone, give the baby two minutes of CPR, then call EMS. If you see a baby that has been down for an unknown time call emergency service first and then give CPR.
  3. Check the baby’s brachial pulse for 5-10 seconds by 2-3 fingers on the inner side of the upper arm. Do not push firmly. If you find an abnormal pulse (much less than 60 per minute) or no pulse – Start CPR. Place the baby on the back. Place two fingers in the center of the baby’s chest below the nipple line and perform 30 compressions. Don’t press on the end of the breastbone. Compression should be 100-120 per minute and the depth should be 1.5 inches. Count compression loudly.
  4. Open the airway by tilting the head slightly up and lifting the chin. To check if the position is right – level the baby’s external ear canal with the top of the shoulder. Do not let the head fall too back. Also, do not let the chin fall back towards the neck. You can use your other hand to make sure that the head is in the right position even while you perform compression.
  5. Give the baby two rescue breaths for one second each. Do not push too much air just enough to make the chest rise.
  6. After two minutes or five rounds of compression. Call the emergency service and look for AED (Automated External Defibrillator). Use AED if available. Else continue performing CPR on a baby.

Two Rescuer CPR for Infants

Two Rescuer CPR for Infants
  1. Rescuer 1 should check for responsiveness in the baby by tapping the sole of feet and calling the baby loudly. Check for breathing. If a baby has abnormal or no breathing at all, ask Rescuer 2 to call emergency service and bring AED if available.
  2. Rescuer 1 should check the baby’s brachial pulse for 5-10 seconds by 2-3 fingers in the inner side of the upper arm. Do not push firmly. If you find an abnormal pulse (much less than 60 per minute) or no pulse – Start CPR.
  3. Until rescuer 2 comes back, Rescuer 1 should – Place the baby on the back. Place two fingers in the center of the baby’s chest below the nipple line and perform 30 compressions. Don’t press on the end of the breastbone. Compression should be 100-120 per minute and the depth should be 1.5 inches. Count compression loudly.
  4. Open the airway by tilting the head slightly up and lifting the chin. To check if the position is right – level the baby’s external ear canal with the top of the shoulder. Do not let the head fall too back. Also, do not let the chin fall back towards the neck. You can use your other hand to make sure that the head is in the right position even while you perform compression.
  5. Give the baby two rescue breaths for one second each. Do not push too much air just enough to make the chest rise.
  6. When the Rescuer 2 returns change the compression ratio to 15: 2 that is 15 compression two breaths.
  7. Rescuer 2 should place the thumb of both hands in the center of the baby’s chest below the nipple line. Make sure to not push the end of the breastbone. Place the fingers on the infant’s back. Use the thumb to give 15 compressions. The rate and depth of compression should be the same as above.
  8. Rescuer 1 should give two rescue breaths as above.
  9. Until the help arrives, continue CPR at a 15:2 ratio and switch positions every two minutes to avoid fatigue.
  10. Use AED as soon as available.

If possible, read all the above information once again to not make any mistakes while you are in a life and death situation. Learning how to perform CPR on a baby is important as no one knows when this life-saving skill comes in handy. You can also get CPR training from certified classes as hands-on experience is always better.

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